Azelaic Acid: The Underrated Multitasker for Indian Skin

How azelaic acid works

Three mechanisms: (1) Anti-acne: inhibits Cutibacterium acnes growth via disruption of cellular proteins — without antibiotic resistance risk. (2) Anti-pigmentation: inhibits tyrosinase (the enzyme that catalyses melanin synthesis) selectively in hyperactive melanocytes, without affecting normally-pigmented skin. (3) Anti-inflammatory: reduces prostaglandin synthesis and keratinocyte activation, directly addressing rosacea pathophysiology. No other single OTC ingredient achieves all three simultaneously.

Prescription vs. OTC azelaic acid

At 15–20% (prescription-strength), azelaic acid achieves efficacy equivalent to metronidazole 0.75% for rosacea and comparable to HQ 4% for melasma. OTC formulations at 10% provide partial efficacy with lower irritation risk — appropriate for sensitive skin starting protocols. Mixing with a simple moisturiser (buffering) allows higher strengths to be tolerated.

Key ingredients · Evidence summary